I. Pathogenic factors, symptoms and high-risk groups of lumbar disc herniation (a) pathogenic factors: 1. increase in abdominal pressure: 1/3 of patients have this trigger, such as: violent coughing and sneezing, breath-holding, constipation, etc.; 2. postural malposition: whether during sleep or daily life, work, when the lumbar region is in flexion, such as sudden rotation is prone to trigger the disease; 3. sudden weight bearing; 4. Lumbar trauma, especially violence is light, not enough to cause fracture dislocation of trauma may have degenerated nucleus pulposus protrusion; 5, lumbar cold, the cause of the lumbar muscle spasm, small blood vessel contraction, affecting the local blood supply, so that the intervertebral disc nutritional disorders, increase the burden on the disc, so that the degenerated fibrous ring injury aggravated, and the nucleus pulposus protrusion; 6, spinal deformity: congenital and secondary spinal deformity patients. Because the intervertebral disc is not only unequal in width, and there is often torsion, which makes the pressure on the fibrous ring is not the same, and easy to accelerate the degeneration of the intervertebral disc. (B) Symptoms of lumbar protrusion: Low back pain and lower limb radiating pain are the main symptoms of the disease. The main manifestations: 1, low back pain, lower extremity radiating pain along the sciatic nerve conduction, straight to the lateral calf, dorsal foot or toes. 2. All movements that increase the pressure in the abdomen, such as coughing, sneezing and defecation, can aggravate the low back pain and lower extremity radiating pain. 3.The pain increases with activity and decreases after rest. (3) High-risk groups: People engaged in heavy physical labor and weight lifting; automobile and tractor drivers; people who need poor body position for work. Statistics show that 53% of the light workers and 64% of the heavy workers have low back pain, and 35% of those who suffer from low back pain develop this disease. The disease is mostly seen in male young adults, and can be seen in all walks of life, except for workers and athletes who work too hard, and general office workers are not uncommon, often in the lumbar 4-5, lumbar 5-sacral 1. II. Current treatment methods Non-surgical treatment Most patients with lumbar disc herniation can be relieved or cured by non-surgical treatment. The treatment principle is not to return the degenerated and herniated disc tissue to its original position, but to change the relative position of the disc tissue and the compressed nerve root or partially retract it, so as to reduce the pressure on the nerve root, release the adhesion of the nerve root and eliminate the inflammation of the nerve root, thus relieving the symptoms. Non-surgical treatment is mainly suitable for: 1) young people, first time attack or short duration of the disease; 2) people with mild symptoms that can be relieved by themselves after rest; 3) people with no obvious spinal stenosis on imaging. (1) Absolute bed rest For the first attack, bed rest should be strictly applied, emphasizing that neither large nor small stools should be taken out of bed or sitting up, so as to have better results. After 3 weeks of bed rest, you can get up and move around under the protection of a lumbar girth, and do not bend over and hold things for 3 months. This method is simple and effective, but more difficult to adhere to. After remission, the lumbar back muscle exercise should be strengthened to reduce the chance of recurrence. (2) Traction therapy The use of pelvic traction can increase the width of the intervertebral space, reduce the internal pressure of the intervertebral disc, the protruding part of the disc retracts, and reduce the irritation and compression of the nerve root, which needs to be carried out under the guidance of a professional doctor. (3) Physiotherapy, massage and tui-na can relieve muscle spasm and reduce pressure within the intervertebral disc, but note that violent massage and tui-na can lead to aggravation of the disease and should be done with caution. (4) Corticosteroid epidural injection Corticosteroid is a long-acting anti-inflammatory agent, which can reduce inflammation and adhesions around the nerve root. Generally, long-acting corticosteroid preparation + 2% lidocaine is used for epidural injection once a week, 3 times as a course of treatment, and another course of treatment can be used after 2-4 weeks. (5) Chemical lysis of the nucleus pulposus Using collagenase or papain, injected into the intervertebral disc or between the dura and the herniated nucleus pulposus, selectively dissolve the nucleus pulposus and the fibrous ring without damaging the nerve roots, in order to reduce the pressure in the disc or make the herniated nucleus pulposus smaller so as to relieve the symptoms. However, there is a risk of allergic reaction to this method. 2.Percutaneous myelotomy/myeloplasty The nucleus pulposus will be suctioned out or laser vaporized by entering the intervertebral space under X-ray surveillance with special instruments, so as to reduce the pressure in the intervertebral disc and achieve symptomatic relief. 3.Surgical treatment (1) Indications for surgery: history of more than three months, strictly conservative treatment is ineffective or conservative treatment is effective, but frequent recurrence and heavy pain; the first attack, but the pain is severe, especially in the lower extremities, the patient is difficult to move and sleep, in a forced position; combined with the expression of cauda equina compression; single nerve root paralysis, accompanied by muscle atrophy, muscle strength loss; combined with spinal stenosis. (2) Surgical method A posterior lumbar back incision is made, and part of the lamina and articular eminence is removed, or a disc is removed through the lamina space. For central disc herniation, after laminectomy, epidural or intradural discectomy is performed. In cases of combined lumbar instability and lumbar spinal stenosis, simultaneous spinal fusion is required. Third, lumbar disc herniation prevention and self-care of patients with lumbar disc herniation 1, prevention: prevention of lumbar disc herniation should start from school, family, work and pre-vocational training, so that every worker understands the normal spine physiology, correct labor posture, pay attention to labor protection, avoid accelerating lumbar disc degeneration and injury on the basis of lumbar disc degeneration. Preventive measures should start from the following aspects: health checkups should be conducted regularly for adolescents or staff, and at the same time, publicity and education on the prevention of lumbar disc herniation should be widely carried out. The labor department should stipulate the maximum amount of load to engage in labor to avoid overloading the spine to promote and accelerate degeneration. Correct labor posture and combination of work and rest. Strengthen muscle exercise strong back muscles, so that the balance of spinal strength can prevent soft tissue damage to the lumbar back and reduce the occurrence of lumbar disc herniation. 2, self-care: First of all, patients with lumbar disc herniation should pay attention to several points: the acute stage should sleep on a hard bed, absolute bed rest for 3 weeks. Avoid coughing, sneezing and preventing constipation. After the symptoms improve significantly, gradually carry out back muscle exercises and do light activities on the ground under the protection of lumbar circumference. To prevent recurrence of lumbar disc herniation, patients with lumbar disc herniation can be relieved or cured after treatment and rest, but the recurrence rate of the disease is quite high. The next is the exercise method: the lumbar circumferential movement as well as backward walking is very effective in treating and preventing lumbar spine pain. (1) around the ring exercise: legs slightly apart, two hands forked in the back of the waist, the waist as the axis of rotation around the body, if the pain is very strong, you can move more slowly, first to the left, then to the right. This method is simple, but it works, so we suggest you try it. (2) backwards walk: backwards walk should be 1 time a day in the morning and evening, 20-30 minutes each time, to be progressive. Lumbar spine pain is very strong if you can immediately backward walking exercise, can play a good role in pain relief, chronic lumbar spine patients who can adhere to long-term backward walking, two months will see good results.